Sangue e fígado: a persistência das imagens simbólicas sobre a lepra a partir do mito do Papa-Figo / Blood and liver: the persistence of the leprosy symbolic images considering the Papa-Figo myth / Sangre e hígado: la persistencia de las imágenes simbólicas de la lepra a partir del mito de Papa-Figo

Este artigo volta-se para os processos simbólicos que, frente à iminência do adoecimento e da morte, fazem emergir no imaginário poderosas narrativas que se dinamizam em mitos. Elege, para isso, as imagens simbólicas sobre a lepra que circundam o mito do Papa-Figo ­ criatura fantástica, ele é representado por ricos e poderosos que, contaminados, fariam de tudo para recuperar sua saúde; inclusive consumir vísceras de crianças sequestradas. Em um percurso sincrônico e diacrônico, relacionamos relatos históricos e folclóricos com narrativas contemporâneas: vídeos de exploração à casa da 'viúva Papa-Figo'. Nesta leitura simbólica, exploramos a recorrência dos símbolos de sangue, fígado, poço, poder, dinheiro e de um Outro misterioso, mostrando que o medo da doença e suas consequências físicas e sociais nos movimentam arquetipicamente, despertando relações ancestrais que nos conectam com o plano da experiência humana.

This article is focused on the symbolic processes that, in the face of the imminence of illness and death, make powerful narratives emerge in the imaginary, which are symbolized by myths. For this purpose, we center on the symbolic images on leprosy that surround the Brazilian myth of the Papa-Figo - a fantastic creature represented by the rich and powerful people which were contaminated and would do anything to recover from the illness and back to their health; including consuming the entrails of kidnapped children. In a synchronic and diachronic journey, we related historical and folkloric reports to contemporary narratives: urban exploration videos exploring the abandoned house of the 'Papa-Figo widow'. In this symbolic reading, we explore the recurrence of symbols linked to blood, liver, well, power, money and the mysterious Other, showing that the fear of disease and its physical and social consequences move us archetypically, awakening ancestral relationships that connect us to the experience human level.

Este artículo se centra en los procesos simbólicos que, en vista de la inminencia de la enfermedad y de la muerte, hacen que surjan narrativas poderosas en el imaginario simbolizadas en mitos. Para este propósito, elegimos las imágenes simbólicas sobre la lepra que rodean el mito brasileño llamado Papa-Figo, una criatura fantástica representada por personas ricas y poderosas que, contaminadas con la enfermedad, harían cualquier cosa para recuperar su salud; incluyendo el consumo de las entrañas de niños secuestrados. En un camino sincrónico y diacrónico, relacionamos los relatos históricos y folclóricos con narrativas contemporáneas: vídeos de exploración urbana a la casa de la 'viuda Papa-Figo'. En esta lectura simbólica exploramos la recurrencia de símbolos vinculados a la sangre, al hígado, al pozo, al poder, al dinero y al Otro misterioso, mostrando que el miedo a la enfermedad y sus consecuencias físicas y sociales nos mueven arquetípicamente, despertando relaciones ancestrales por las cuales nos conectamos con el plano de la experiencia humana.

Host immune responses induced by specific Mycobacterium leprae antigens in an overnight whole-blood assay correlate with the diagnosis of paucibacillary leprosy patients in China.

BACKGROUND: Leprosy, caused by Mycobacterium leprae, affects over 200,000 people annually worldwide and remains endemic in the ethnically diverse, mountainous and underdeveloped southwestern provinces of China. Delayed diagnosis of leprosy persists in China, thus, additional knowledge to support early diagnosis, especially early diagnosis of paucibacillary (PB) patients, based on the host immune responses induced by specific M. leprae antigens is needed. The current study aimed to investigate leprosy patients and controls in Southwest China by comparing supernatants after stimulation with specific M. leprae antigens in an overnight whole-blood assay (WBA) to determine whether host markers induced by specific M. leprae antigens improve the diagnosis or discrimination of PB patients with leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Leprosy patients [13 multibacillary (MB) patients and 7 PB patients] and nonleprosy controls [21 healthy household contacts (HHCs), 20 endemic controls (ECs) and 19 tuberculosis (TB) patients] were enrolled in this study. The supernatant levels of ten host markers stimulated by specific M. leprae antigens were evaluated by overnight WBA and multiplex Luminex assays. The diagnostic value in PB patients and ECs and the discriminatory value between PB patients and HHCs or TB patients were evaluated by receiver operator characteristics (ROC) analysis. ML2044-stimulated CXCL8/IL-8 achieved the highest sensitivity of 100%, with a specificity of 73.68%, for PB diagnosis. Compared to single markers, a 3-marker combination model that included ML2044-induced CXCL8/IL-8, CCL4/MIP-1 beta, and IL-6 improved the diagnostic specificity to 94.7% for PB patients. ML2044-stimulated IL-4 and CXCL8/IL-8 achieved the highest sensitivity (85.71% and 100%) and the highest specificity (95.24% and 84.21%) for discriminating PB patients from HHCs and TB patients, respectively. CONCLUSIONS: Our findings suggest that the host markers induced by specific M. leprae antigens in an overnight WBA increase diagnostic and discriminatory value in PB patients with leprosy, with a particularly strong association with interleukin 8.

Non-exponential growth of Mycobacterium leprae Thai-53 strain cultured in vitro.

In this study, attempts were made to culture this bacterium in media supplemented with a variety of biological materials to determine why cultivation of Mycobacterium leprae in vitro has not this far been successful. A slight increase in the number of cells in medium supplemented with human blood plasma and an extract of nude mouse tissue as observed after more than 3 months of cultivation at 30 °C. To ascertain whether this increase was real growth, the growth was analyzed by droplet digital PCR, which showed a slow increase in the copy number of cell-associated DNA and the release of a large amount of DNA into the culture medium from bacterial cells during cultivation. These results were supported by electron microscopic examination of M. leprae in infected mouse tissues, which showed that most of the replicated bacteria had degenerated and only a few cells survived. Based on these results, it was postulated that many of the replicated cells degenerate during M. leprae growth and that only a few cells remain to participate in the next growth stage. This means that, unlike other cultivable bacteria, the growth of M. leprae is not exponential and the number of cells therefore increase extremely slowly. Thus, accurate judging of the success of M. leprae cultivation requires observation of growth over a long period of time and careful measurement of the increase in number of viable cells.

Leprosy Reactions Show Increased Th17 Cell Activity and Reduced FOXP3+ Tregs with Concomitant Decrease in TGF-ß and Increase in IL-6.

BACKGROUND: 50% of leprosy patients suffer from episodes of Type 1/ reversal reactions (RR) and Type 2/ Erythema Nodosum Leprosum (ENL) reactions which lead to morbidity and nerve damage. CD4+ subsets of Th17 cells and CD25+FOXP3+ regulatory T cells (Tregs) have been shown to play a major role in disease associated immunopathology and in stable leprosy as reported by us and others. The aim of our study was to analyze their role in leprosy reactions. METHODOLOGY AND PRINCIPLE FINDINGS: Quantitative reverse transcribed PCR (qPCR), flowcytometry and ELISA were used to respectively investigate gene expression, cell phenotypes and supernatant levels of cytokines in antigen stimulated PBMC cultures in patients with stable disease and those undergoing leprosy reactions. Both types of reactions are associated with significant increase of Th17 cells and associated cytokines IL-17A, IL-17F, IL-21, IL-23 and chemokines CCL20, CCL22 as compared to matching stable forms of leprosy. Concurrently patients in reactions show reduction in FOXP3+ Treg cells as well as reduction in TGF-ß and increase in IL-6. Moreover, expression of many T cell markers, cytokines, chemokines and signaling factors were observed to be increased in RR as compared to ENL reaction patients. CONCLUSIONS: Patients with leprosy reactions show an imbalance in Th17 and Treg populations. The reduction in Treg suppressor activity is associated withhigherTh17cell activity. The combined effect of reduced TGF-ß and enhanced IL-6, IL-21 cytokines influence the balance between Th17 or Treg cells in leprosy reactions as reported in the murine models and autoimmune diseases. The increase in Th17 cell associated cytokines may contribute to lesional inflammation.

Células CD3+, CD4+, CD8+, CD3-CD16+CD56+ e CD19+ em sangue periférico de pacientes com hanseníase e indivíduos saudáveis

A hanseníase é uma doença granulomatosa, infecto-contagiosa causada pelo Mycobacterium leprae. Trata-se de uma infecção crônica com amplo espectro de respostas imunes celulares em humanos. Possui alto poder infectante e baixo poder patogênico. Este estudo tem como objetivo quantificar e comparar leucócitos e sub populações de linfócitos T totais (CD3+), T auxiliares (CD3+CD4+), T citotóxicos (CD3+CD8+), B (CD19+) e NK (CD3-CD16+CD56+) em sangue periférico de indivíduos com hanseníase e controles saudáveis.Os pacientes foram provenientesdo Centro de Dermatologia D. Libânia, Fortaleza-CE, Brasil. A determinaçãodo número de linfócitos em cada subpopulação foi realizada porcitometria de fluxo.Aanálise estatísticafoi realizadapelo programa Grap hPad Prism 5.0para Windows comsignificância estabelecida para valores de p<0,05.É um estudo do tipo caso controle de caráter observacional, realizado a partir da análise do sangue periférico de indivíduos com diagnóstico de hanseníase e de indivíduos saudáveis.A população de pacientes com hanseníase, sem tratamento foi composta de 15 pessoas. A população de controles saudáveis foi composta por 29 pessoas...

Leprosy is an infectious and granulomatous disease caused by Mycobacterium leprae. The aim of this study was to quantify and compare levels of leucocytes and lymphocyte subpopulations (CD3+, CD3+CD4+, CD3+CD8+, CD19+, CD3-CD16+CD56+) in peripheral blood ofpatients with leprosy and healthy controls. Patients were followed at Centro de Dermatologia D. Libânia, Fortaleza-CE, Brasil. Flow cytometry was used to determine numbers of lymphocytes. Statistical analisys was done with GraphPad Prism 5.0 software for windows. P values under 0.05 were considered siginificant.This was an observational case-control study. Fifteen leprosy patients without treatment were evaluated and 29 healthy individuals were included in control group...

Comparative evaluation of PCR amplification of RLEP, 16S rRNA, rpoT and Sod A gene targets for detection of M. leprae DNA from clinical and environmental samples.

PURPOSE: PCR assay is a highly sensitive, specific and reliable diagnostic tool for the identification of pathogens in many infectious diseases. Genome sequencing Mycobacterium leprae revealed several gene targets that could be used for the detection of DNA from clinical and environmental samples. The PCR sensitivity of particular gene targets for specific clinical and environmental isolates has not yet been established. The present study was conducted to compare the sensitivity of RLEP, rpoT, Sod A and 16S rRNA gene targets in the detection of M. leprae in slit skin smear (SSS), blood, soil samples of leprosy patients and their surroundings. METHOD: Leprosy patients were classified into Paucibacillary (PB) and Multibacillary (MB) types. Ziehl-Neelsen (ZN) staining method for all the SSS samples and Bacteriological Index (BI) was calculated for all patients. Standard laboratory protocol was used for DNA extraction from SSS, blood and soil samples. PCR technique was performed for the detection of M. leprae DNA from all the above-mentioned samples. RESULTS: RLEP gene target was able to detect the presence of M. leprae in 83% of SSS, 100% of blood samples and in 36% of soil samples and was noted to be the best out of all other gene targets (rpoT, Sod A and 16S rRNA). It was noted that the RLEP gene target was able to detect the highest number (53%) of BI-negative leprosy patients amongst all the gene targets used in this study. CONCLUSION: Amongst all the gene targets used in this study, PCR positivity using RLEP gene target was the highest in all the clinical and environmental samples. Further, the RLEP gene target was able to detect 53% of blood samples as positive in BI-negative leprosy cases indicating its future standardization and use for diagnostic purposes.

Asymptomatic Leprosy Infection among Blood Donors May Predict Disease Development and Suggests a Potential Mode of Transmission.

Blood donor samples (1,007) were assessed for anti-phenolic glycolipid 1 (PGL-1) IgM antibodies and Mycobacterium leprae DNA presence, which had 3.8% and 0.3% positivity, respectively. After a 5-year follow-up period, six individuals with positive markers developed leprosy, raising the hypothesis that asymptomatic infection among blood donors may be an undisclosed mode of leprosy transmission via transfusion.

QuantiFERON TB Gold: a new method for latent tuberculosis infection.

QuantiFERON-TB Gold obtained approval in 2003 by the Food and Drug Administration as a valid tool for the diagnosis of latent tuberculosis. In this report, we evaluated its potential use in the immunological diagnosis of Mycobacterium tuberculosis infections in different groups of subjects. Our data indicate that QuantiFERON-TB Gold is specific for identifying subjects who have come into contact with M. tuberculosis and its use alongside traditional diagnostic techniques may be an important instrument for controlling tuberculosis.

[Chronobiological aspects of the action of diaminodiphenylsulfone on hematological mice induces in summer and winter seasons ]. / Khronobiologicheskie aspekty vliianiia diaminodifenilsul'fona na gematologicheskie pokazateli u myshei v letnii i zimnii sezony goda.

Mice experiments were made to study effects of diaminodiphenylsulphone (DDS)--basic antileprous drug--on circadian rhythms of hemoglobin levels, counts of red cells and leukocytes. The time of the drug administration varied within the day while seasons of the year were two--winter and summer. Blood components were studied with unified methods. The results of the study showed that DDS has significant effects on the structure of circadian rhythms of the above blood components. These effects correlate with the season of the year and time of DDS administration.

Avaliacao de provas laboratoriais utilizadas para detectar deficiencias da glicose-6-fosfato desidrogenase (G6PD) no sangue total / Evaluation of laboratory tests used to detect glucose-6-phosphate dehydrogenase (G6PD) deficiencies in whole blood

A deficiência do G6PD é frequente entre brasileiros. A exposição de seus portadores a determinados medicamentos pode desencadear hemolise. Sendo assim, conveniente uma pré-determinação da G6PD antes do tratamento com medicamentos oxidantes. Avaliamos duas metodologias, para detectar pacientes de G6PD no sangue. A técnica Qualitativa, apesar de mais pratica e econômica não apresenta resultados precisos e exatos, servindo apenas como triagem. Enquanto a técnica Quantitativa, mesmo sendo de custo elevado, dificultando a sua aquisição, apresenta vantagens para determinar a atividade enzimática com maior exatidão.

[Practical aspects of mechanical autotransfusion in tumor surgery in a decentralized clinic]. / Praktikabilität der maschinellen Autotransfusion in der Tumorchirurgie an einem dezentralen Klinikum.

The surveys of Hansen et al. demonstrated the safe inactivation of tumor cells in salvaged blood by g-irradiation. This method opens up the possibility of extending the intraoperative autotransfusion to tumour surgery. A prospective survey at the University Hospital of Leipzig demonstrated the practicability of intraoperative autotransfusion with gamma-irradiation of salvaged blood at a hospital with a decentralized structure. A clinically-relevant reduction of quality of the blood product by gamma-irradiation with 50 Gray or by transport was not observed. Adherence to fixed working regulations ensures that gamma-irradiation is conducted correctly and the salvaged erythrocyte concentrate is available in an acceptable period of time.

Autoapheresis and intraoperative blood salvage in oncologic surgery.

Transfusion of predeposit or salvaged autologous blood has continued to grow since the 1980s. Issues such as the indications for use and cost effectiveness as well as the safety of autologous blood salvaged during cancer surgery have emerged and should be addressed. The concern for possible contamination of autologous RBC with cancer cells responsible for metastasis has limited the use of autologous salvaged blood in cancer patients. Nevertheless, clinical experience has been gained on the use of salvaged blood in patients with colorectal, gastric, renal, hepatic, breast, bladder and lung cancer. No evidence has been reported showing an increase in metastasis or a decrease in patient survival, in spite of the obvious demonstration that salvaged blood is contaminated with viable tumor cells which are not washed out of the RBC layer during intraoperative blood salvage (IOBS). However, a number of limitations have hampered the widespread use of IOBS in these patients and the technique is not well established. Increasing knowledge of the deleterious effects of allogeneic blood transfusion both in terms of the increased number of viral or bacterial infections and the down-regulation of the patient's immune system have recalled attention to IOBS and to the techniques such as filtration, which might reduce the risk of reinfusion of cancer cells, or totally eliminate the risks such as irradiation has been proposed by Hansen's group. This paper reviews the topic with some emphasis on our personal experience with gamma and X-ray irradiation of salvaged blood in a large reference hospital, where IOBS and filtration of salvaged blood were established for use in cancer patients in 1993 and 1996.

The use of whole blood in a dipstick assay for detection of antibodies to Mycobacterium leprae: a field evaluation.

We describe a further simplification of a dipstick assay for the detection of antibodies to phenolic glycolipid I of Mycobacterium leprae by using whole blood and evaluated the assay performance in the leprosy endemic area of Amazonas in Brazil. The agreement with the 'gold' standard ELISA was 94.9% (kappa value = 0.87). This simple assay may be useful to identify those at risk of developing leprosy, for example among contacts of leprosy patients at lower levels in the health services.

Rapid detection and identification of microorganisms from blood cultures.

In an era characterized by increasing emphasis on minimizing laboratory costs, reliable and cost-effective methods for rapidly identifying bacteria and fungi directly from blood cultures have a great deal of appeal to clinical microbiologists. A variety of methods have been evaluated and found to be useful under certain conditions, although none of the methods has been standardized and questions remain as to whether their use improves patient care or reduces hospital costs. Even if these methods do not improve patient care or reduce hospital costs, their use and expense could be justified if they improve laboratory work flow or decrease laboratory costs or both. Several issues remain unresolved, one of which is whether the use of rapid identification methods with a continuous-monitoring blood culture system might allow for a clinically important decrease in the time required to identify blood culture isolates. Another issue is whether subsequent isolation by culture is necessary for microorganisms with predictable antimicrobial susceptibility patterns. These and other issues need to be studied further before the exact clinical usefulness of rapid methods will be known. At this time, no commercial product has been cleared or approved by the Food and Drug Administration (FDA) for the direct detection or identification of both of pathogenic microorganisms from blood culture bottles (Sharon Hansen, PhD, personal communication, 1993). Consequently, laboratory directors should exercise caution in the use of commercial or other products for direct blood culture testing, because manufacturers assume no liability for products that are used for purposes other than that for which they have been approved. In addition, such use of commercial products may be in violation of the rules set forth in the Clinical Laboratory Improvement Act of 1988. Furthermore, as discussed previously, the clinical performance characteristics of many products typically have not been determined, and, therefore, test reference ranges, sensitivity, specificity, and positive and negative predictive values have not been established. Other issues, such as the effect of different blood culture media and additives, also have not been studied adequately, nor are specific controls defined. Therefore, laboratory staff who would like to use commercial products to test blood cultures directly must themselves establish the performance characteristics of the product (keeping in mind the issue of liability) or, preferably, persuade manufacturers to sponsor large-scale controlled clinical trials both to establish performance characteristics and to obtain FDA clearance or approval for such usage of the product.(ABSTRACT TRUNCATED AT 400 WORDS)

Anticardiolipin antibodies and dependence of a serum cofactor. A mechanism of thrombosis.

OBJECTIVE: To evaluate the dependence on the serum cofactor of anticardiolipin antibodies (aCL) in infectious and autoimmune diseases. We also studied their correlation with some clinical manifestations, specially thrombosis. METHODS: aCL were determined with a standard ELISA method, and a modified ELISA in which we substituted bovine serum albumin (BSA), gelatin and skim milk powder for fetal calf serum (FCS). Categorized variables were analyzed by means of the chi 2 test and Fisher's test. Four groups of patients were studied. Group 1. Patients with aCL and autoimmune disease (systemic lupus erythematosus [SLE] and the primary antiphospholipid syndrome [PAPS]). Group 2. Patients with aCL, no symptoms and no underlying infection or autoimmune disease. Group 3. Patients with aCL and infectious diseases (syphilis, leprosy, HIV infection and Q fever). Group 4. Control group. RESULTS: (a) 19 of 20 samples from patients in Group 1 disclosed cofactor dependence in aCL activity. (b) 17 of 19 samples from patients in Group 3 had aCL activity, that was independent of the presence of the cofactor. (c) 3 of 4 patients in Group 2 had cofactor independent aCL and one had cofactor dependent aCL activity. (d) no control group patient had aCL. (e) association of cofactor dependent aCL with the development of clinical manifestations (thrombosis) was statistically significant (p < 0.0001). (g) cofactor dependent aCL and cofactor independent aCL were, respectively, associated with autoimmune and infectious diseases (p < 0.0001). CONCLUSIONS: (a) Dependence or independence of the cofactor helps to differentiate "infectious" aCL from "autoimmune" aCL. (2) aCL related clinical manifestations (thrombosis) depends on the presence of cofactor dependent aCL and not on cofactor independent aCL.

Detection of antibodies to 35 kD determinant of M. leprae in urine and serum of leprosy patients.

Urine and serum samples from 67 subjects comprising 55 active cases of different types of leprosy and 12 normal controls were subjected to monoclonal antibody based urine antibody competition test (UACT) and serum antibody competition test (SACT) respectively. It was possible to demonstrate M. leprae specific antibodies in the urine of 50% of the seropositive subjects. Urine antibody positivity was observed to the extent of 52% in BL/LL subjects, 50% in BB and 43% in TT/BT types of leprosy.

Effect of temperature, cholesterol and nerve tissue on multiplication of armadillo M. leprae.

The effect of temperature, nerve tissue and certain constituents of the medium on multiplication of armadillo M. leprae was studied using Hanks BSS. An equal or better growth was seen at 30 degrees C and 10 degrees C compared to 37 degrees C. Multiplication was also seen at -20 degrees C. Adding cholesterol, foetal calf serum, cystine-HCl, sodium thioglycollate or nerve suspension and covering medium with liquid paraffin each showed beneficial effect. Hanks containing foetal calf serum, cholesterol with sodium thioglycollate or cystine-hydrochloride showed maximum multiplication. These combinations may be used for testing additional factors for further improvement of the medium.

Bacillaemia in leprosy: correlation with slit-skin and nasal smears.

Twenty five multibacillary patients (BL/LL) were studied for bacillaemia. Majority (76%) showed acid fast bacilli in peripheral blood. There was good correlation between bacillary load in peripheral blood and bacteriological index (BI) but poor correlation with morphological index (MI) of skin slit smear and BI/MI of nasal smear.